Sixth Circuit Affirms Lincoln Life’s Denial of Long-Term Disability Benefits Due to Claimant’s Failure to Show Continuous Disability during Elimination Period

In Tranbarger v. Lincoln Life & Annuity Co. of New York, No. 22-3369, __F.4th__, 2023 WL 3527418 (6th Cir. May 18, 2023), the Sixth Circuit court of appeals considered whether Plaintiff-Appellant Vickie Tranbarger demonstrated her entitlement to disability benefits under an ERISA-governed long-term disability policy insured by Defendant-Appellee Lincoln Life & Annuity Company of New York. In affirming the district court’s grant of judgment to Lincoln Life, the Sixth Circuit declined to resolve an open question in the Sixth Circuit as to the standard of review the court should apply to the district court’s decision. The district court applied de novo review to Lincoln Life’s decision because the LTD policy did not vest Lincoln Life with discretionary authority. The Sixth Circuit concluded that under either de novo or clear error review, Tranbarger’s claim fails.

In affirming the decision, the court noted that the definition of disability is a stringent one. One must demonstrate “continuous” disability during the 6-month Elimination Period. “Even one day of partial work ability during the Elimination Period is enough to defeat Tranbarger’s claim.” Tranbarger claimed disability due to fibromyalgia and chronic fatigue syndrome. Medical records documenting her condition during the Elimination Period showed that she was limited by pain and fatigue and struggled to perform the job duties of an accounts receivables manager. The Social Security Administration (“SSA”) also found her disabled under its rules as of the start of the Elimination Period. But the court noted that physical therapy records during the relevant time frame recorded Tranbarger as stating she had “no pain” though she continued to experience fatigue. The court was not persuaded that Tranbarger’s records showed that she was continuously unable to perform the main duties of her former position, one which was sedentary but required moderate to high aptitude abilities and the ability to talk frequently. The court found that ample evidence suggests that she could perform some work in some instances. The court disregarded treating doctor opinions finding Tranbarger totally disabled from working in any occupation because these opinions were rendered years after the Elimination Period closed. Similarly, the court did not find the SSA award of disability persuasive since it relied on evidence generated after the post-Elimination Period.

Judge Nalbandian penned a concurring opinion finding that the caselaw requires de novo review of the district court’s factfinding.